States of health (Editorial analysis of NITI AAyog's Report on Health)

The report ranks states and Union territories innovatively on their year-on-year incremental change in health outcomes, as well as, their overall performance with respect to each other.

The report said common challenges for the states is to address vacancies in key staff, establishment of Cardiac Care Units and quality accreditation of public health facilities.

Healthy States, Progressive India Report

The aim was to establish an annual systematic tool to measure and understand the heterogeneity and complexity of the nation’s performance in Health.

The report has been developed by NITI Aayog, with technical assistance from the World Bank, and in consultation with the Ministry of Health and Family Welfare (MoHFW).

States and UTs have been ranked in three categories namely, Larger States, Smaller States, and Union Territories (UTs), to ensure comparison among similar entities.

What domains does the Health index cover?

The Health Index is a weighted composite Index, which for the larger States, is based on indicators in three domains: (a) Health Outcomes (70%); (b) Governance and Information (12%); and (c) Key Inputs and Processes (18%).

What are the key highlights of the Report?

States with a record of investment in literacy, nutrition and primary health care have achieved high scores in NITI Aayog’s first Health Index.

Among Larger States:

Kerala, Punjab and Tamil Nadu have ranked top among the larger states in terms of overall performance.Jharkhand, Jammu and Kashmir and Uttar Pradesh are at top in the terms of annual incremental performance in indicators such as Neonatal Mortality Rate (NMR), Under-five Mortality Rate (U5MR), full immunization coverage, institutional deliveries, and People Living with HIV (PLHIV) on Anti-Retroviral Therapy (ART).Among Smaller States:

Among Smaller States, Mizoram ranked first followed by Manipur on overall performance, while Manipur followed by Goa were the top ranked States in terms of annual incremental performance.Manipur registered maximum incremental progress on indicators such as PLHIV on ART, first trimester antenatal care (ANC) registrationAmong UTs:

Lakshadweep showed both the best overall performance as well as the highest annual incremental performance.Lakshadweep showed the highest improvement in indicators such as institutional deliveries, tuberculosis (TB) treatment success rate.What are the common challenges to states in Health sector?

About one-third of the States have registered a decline in their performance in 2016 as compared to 2015 stressing the need to pursue domain-specific, targeted interventions.States and UTs need to focus on addressing vacancies in key staff, establishment of functional district Cardiac Care Units (CCUs), quality accreditation of public health facilities and institutionalization of Human Resources Management Information System (HRMIS).Almost all Larger States need to focus on improving the Sex Ratio at Birth (SRB).What is the goal of this new report?

Health Index has been developed as a tool to leverage co-operative and competitive federalism to accelerate the pace of achieving health outcomes.

Centre provides financial and policies support and it is the responsibility of the states to deliver Health services.

With the annual publication of the Index, it is expected to keep every stakeholder alert to the achievement of Sustainable Development Goals (SDGs) Goal number 3.

This Index is expected to encourage States towards further achieving a rapid transformation of their health systems and population health outcomes.

The Index hopes to make a difference here by encouraging a competitive approach for potentially better outcomes. For instance, it should be possible for Odisha to bring down its neonatal mortality rate, estimated to be the highest at 35 per thousand live births.

Way forward

Both the Centre and the States have the responsibility to scale up their investment on health as a percentage of their budgets, to be more ambitious in interventions. Intra-State inequalities need to be addressed.

States should strive to achieve higher scores in the Index by taking systematic improvements to preventive and primary care.

The process of index refinement should involve inputs from the States and UTs, national and international sector experts, and development partners. Data submitted by the States & UTs should be validated by an Independent Validation Agency.

There is an urgent need to improve data systems in the health sector, in terms of representativeness of the priority areas, periodic availability for all States and UTs, and completeness for private sector service delivery.